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Medicare Risk Assessment Centers for Medicare & Medicaid Services (CMS)

Epstein Becker & Green

A Closer Look at Proposed Changes to Medicare Advantage in the “No UPCODE Act”

On March 25, 2025, U.S. Senators Bill Cassidy, M.S. (R-LA) and Jeff Merkley (D-OR) introduced the No Unreasonable Payments, Coding, or Diagnoses for the Elderly (No UPCODE) Act (the “Bill”)....more

Mintz - Health Care Viewpoints

EnforceMintz — Medicare Advantage and Part D Programs to Remain in the Enforcement Spotlight in 2025

As government scrutiny and enforcement targeting the Medicare Advantage (Medicare Part C) program continued in 2024, the industry’s response to agency actions escalated. Last year also resulted in the first sizable Part D...more

King & Spalding

CMS Issues Final 2025 Calendar Year Medicare Physician Fee Schedule Final Rule

King & Spalding on

On November 1, 2024, CMS issued a rule finalizing changes to Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B policies effective on or after January 1, 2025 (the Final Rule). Section 1848 of...more

Baker Donelson

Significant 2024 Medicare Physician Fee Schedule Rule Proposals: E/M, Social Determinants of Health, and Behavioral Health

Baker Donelson on

In this article, we highlight a number of policy proposals in the current year (CY) 2024 Medicare Physician Fee Schedule (MPFS) Proposed Rule that have significant health care delivery and operational implications. These...more

Foley & Lardner LLP

Medicare Revocations and Enrollment Denials: Proposed Rule Adds False Claims Act Judgments and Misdemeanors; Creates New “Stay of...

Foley & Lardner LLP on

Continuing a now annual tradition, the Centers for Medicare & Medicaid Services (CMS) has included expansions and enhancements to its authorities to deny enrollment or revoke a provider’s Medicare billing privileges...more

Foley & Lardner LLP

Key Takeaways from the Foley/PYA “Let’s Talk Compliance” 2-Day Virtual Conference

Foley & Lardner LLP on

Session #1: State of the Healthcare Industry Effective Compliance Plans and Enforcement Trends - In their discussion of compliance program effectiveness and enforcement, attorneys Kolarik and Waltz and Ms. Sumner...more

Health Care Compliance Association (HCCA)

[Event] Research Compliance Conference - June 8th - 10th, Anaheim, CA

Hear about the latest in research compliance - Do you want to learn… - How to prepare for upcoming changes in Medicaid? - Ways to build and maintain a better research compliance work plan for your program? - How...more

Health Care Compliance Association (HCCA)

[Virtual Event] 2022 Managed Care Compliance Conference - February 8th - 9th, 8:25 am - 3:45 pm CST

Can’t attend the conference in-person? The virtual Managed Care Compliance Conference, February 8–9, allows you to hear from industry professionals just like you—all from the comfort of your home or office. Geared towards...more

Health Care Compliance Association (HCCA)

[Event] 2022 Managed Care Compliance Conference - January 30th - February 1st, Phoenix, AZ

Attend our annual event for those who manage compliance at health plan providers. Explore topics and issues that are pertinent to industry professionals like you. Learn the latest practices, share strategies, and connect with...more

McDermott Will & Schulte

[Webinar] CMS Direct Contracting Model: Evaluating Participation and Managing Risk - December 1st, 1:30 pm - 2:30 pm EST

McDermott Will & Schulte on

The Centers for Medicare and Medicaid Services (CMS) Direct Contracting Model presents an exciting move towards value-based care with benefits for participants, providers and patients alike. However, the model raises a number...more

Health Care Compliance Association (HCCA)

OIG report: Payment of $2.6 billion to Medicare Advantage plans raises concerns

Compliance Today (November 2020) - The U.S. Department of Health & Human Services Office of Inspector General (OIG) September 2020 report titled Billions in Estimated Medicare Advantage Payments From Diagnoses Reported...more

Sheppard Mullin Richter & Hampton LLP

HHS OIG Issues Report Critical of Medicare Advantage Risk Adjustment Practices

Earlier this month, the U.S. Department of Health and Human Services Office of the Inspector General (the “OIG”) released a report highlighting concerns about the extent to which Medicare Advantage Organizations (“MAOs”) are...more

Harris Beach Murtha PLLC

GAO Says CMS Must Do More to Protect Medicare Info

In a report released on April 5, 2018, the Government Accountability Office (GAO) concluded that the Centers for Medicare and Medicaid Services (CMS) has not done enough to adequately protect the electronic data of Medicare...more

Carlton Fields

A Category 5 Compliance Problem: Hurricane Irma Gives Providers a Stark Reminder of Emergency Preparedness Realities

Carlton Fields on

The havoc that Hurricane Irma caused in the Caribbean and most of Florida reminds us of the Centers for Medicare and Medicaid Services (CMS) requirements for emergency preparedness, which take effect November 15....more

Alston & Bird

New Initiatives for the New Year: Highlights of the OIG’s 2017 Work Plan

Alston & Bird on

On November 10, 2016, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) issued its 2017 Work Plan. The 2017 Work Plan outlines the areas of special concern to the OIG and...more

Carlton Fields

4 Key Requirements of CMS’ New Emergency Preparedness Rule

Carlton Fields on

In an effort to establish consistent emergency preparedness requirements, increase patient safety, and ensure coordinated responses to catastrophes, the Centers for Medicare and Medicaid Services (CMS) released the Emergency...more

Burr & Forman

Meaningful Use Audits: Proactive Tips for Success

Burr & Forman on

For health care professionals who began accepting Meaningful Use incentive money at the outset of availability under the Medicare option in 2011, the year 2015 is an important year. If the provider has met all core...more

Cozen O'Connor

ACOs And Pay for Value … About the Data

Cozen O'Connor on

It has been over three years since the Centers for Medicare and Medicaid Services (CMS) announced its proposed rule and guidance on the development and implementation of Accountable Care Organizations. About four million...more

McDermott Will & Emery

CMS Announces CY 2014 MA and Part D Rates with Change to Growth Rate Estimates

The Centers for Medicare & Medicaid Services (CMS) released the announcement of CY 2014 payment rates on April 1, which included its change in position regarding the assumption of the "doc fix" in estimates of Medicare...more

The Volkov Law Group

Hospitals And Fraud Enforcement

The Volkov Law Group on

The HHS Office of Inspector General has targeted hospitals for fraud enforcement. It is one of the OIG’s most important initiatives because of the impact it could have on reducing health care costs....more

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